唇腭裂术后上颌骨发育不良骨牵引矫治的临床研究

目的:探讨口内入路牵引成骨技术在唇腭裂术后继发上颌骨发育不良患者成年之前矫治中的作用。方法:对12例9～12岁唇腭裂术后继发上颌骨明显发育不良者,采用高位LeFortI型截骨术,将上颌骨完全断离,安装口内牵引器,按一定的速度和频率牵引上颌骨向前,对术前、术后头颅定位X线侧位片进行颅颌面软硬组织的测量分析,数据以SPSS10.0统计软件包进行t检验。结果:本组病例上颌骨牵引前移明显,SNA角增加7°～11°,软组织鼻尖点、鼻底点及上唇最突点明显前移,面部外形得到明显改善,上下前牙获得正常覆牙合、覆盖关系。随访3～36个月,咬合关系保持稳定。结论:骨牵引成骨技术可以很好地用于矫治唇腭裂术后继发上颌骨发育不良,早期解除上颌骨畸形,使面部软组织得到适应性改变,面型更为协调,避免或减轻口颌系统继发畸形和功能障碍,不失为唇腭裂术后继发上颌骨发育不良的有效治疗方法。

Distraction osteogenesis for correction of maxillary hypoplasia in patients with repaired cleft lip and palate

PURPOSE: To investigate the effect of distraction osteogenesis on maxillary hypoplasia in patients with cleft lip and palate plasty. METHODS: 12 subjects, 8 males and 4 females, aged from 9 to 12 years old with the average age of 10, were included in this clinical study. All patients suffered from maxillary hypoplasia with the crossbite of 7.75 mm and SNA angle of 69 to 76 degree. After a complete high Le Fort I osteotomy, the patients underwent maxillary advancement at a certain speed and frequency. Postsurgical orthodontic treatment was carried out to adjust the occlusion. The lateral cephalometry and profile were evaluated before and after treatment. The data were analyzed with SPSS10.0 soft ware pakage for student's t test. RESULTS: The maxillae moved forward obviously and SNA angles increased 7 to 11 degrees after distraction osteogenesis. As regard to the soft tissues, the nasal tip, the base of the column, and the protruding point of the upper lip were moved forward prominently, the length of the upper lip was increased, and the profile was improved obviously. A normal overlap and overbite relation was acquired and the distracted maxilla remained stable during the follow-up period of 3 to 36 months. CONCLUSION: Distraction osteogenesis is suitable for early correction of maxillary hypoplasia so that the secondary deformity and dysfunction of oromaxillary system could be avoided. While the maxilla is moved forward after distraction, the soft tissue of the middle and lower third of the face accommodated to the changes and the patients's appearance becomes more harmonious. Supported by Guangdong Provincial Medical Science and Technology Research Fund (A2002115).